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• A phenomenological study to explore the stakeholder perspectives on diabetic foot screening. • Current diabetes foot screening is inadequate and has shortcomings. • National cultures and local practices have a detrimental influence on diabetes foot care. Healthcare options for people with diabetes is still not uniform both within and between countries. This is particularly evident for diabetic foot disease. The number of existing documents/guidelines, together with discrepancies which exist between different organizations or countries can lead to confusion for both practicing health care professionals and new countries or organizations who are in the process of developing local clinical guidelines. This study was aimed at exploring different stakeholder perspectives with a view to develop and introduce culturally competent foot screening guidelines. A phenomenological study which incorporated non-structured interviews with eleven local stakeholders and experts related to the field were conducted to explore interviewees' perspectives regarding foot screening guidelines in Malta. Qualitative analysis identified 3 key themes from the data highlighting barriers to the implementation of diabetes foot screening guidelines. These focused on organizational factors, healthcare professional factors and patient factors. Current procedures related to diabetes foot screening has shortcomings. The findings of this study clearly highlight the need for change in current practices if effective diabetic foot screening is to be offered. Recommendations from this study are relevant to other countries especially those who share same cultures and practices. Making changes today and implementing them in the appropriate manner could make a world of difference in diabetes foot care. [ABSTRACT FROM AUTHOR]

Purpose The use of cadavers for medical education purposes and for radiology research methodologies which involve subjective image quality evaluation of anatomical criteria is well documented. The aim of this study was to quantify the impact of cadaver tissue preservation in producing MR images that are representative of living tissue by comparing the visualisation of anatomical structures of the ankle obtained from live and cadaver (fresh frozen and Thiel embalmed) specimens through a visual grading analysis (VGA) study. Methods A VGA study was conducted on an image data set consisting of 4 coronal proton density weighted (PDw) sequences obtained from ankles of a live patient and those of a cadaveric specimen, of which the right ankle was frozen and the left Thiel embalmed. Results Comparison of the image quality scores obtained from: the live patient vs. the Thiel specimen indicate a significant difference (p ≤ 0.05) between the scores in favour of the Thiel specimen; between the live patient vs. the frozen specimen indicate a significant difference (p ≤ 0.05) in favour of the frozen specimen and between the frozen vs. the Thiel specimen indicate a significant difference (p ≤ 0.05) in favour of the Thiel specimen. Conclusions The advantages of the use of cadavers (frozen or Thiel embalmed) has been shown to also apply for use with proton density (PD) MR imaging. The preservation of cadavers especially using Thiel is a suitable alternative for MRI optimisation and protocol development purposes. [ABSTRACT FROM AUTHOR]

To validate a new classification system for bespoke thermoplastic ankle foot orthoses (AFOs). Inter- and intra-observer reliability study. A classification system based on the design and function of AFOs was created. Sixty-three independent observers classified thirty-six photographs of different AFOs, according to the proposed classification system via an online questionnaire. Approximately two weeks later, the same AFOs were classified again by fifty-three of the same participants. All participants were health care professionals, researchers, or technicians with experience in referring for, prescribing, fitting, reviewing, researching or manufacturing AFOs. The mean inter- and intra-observer agreement Fleiss' kappa was 0.932 and 0.944, respectively. 98.3% of participants reported that the classification system was very easy or moderately easy to use, with 85.7% reporting they would use the classification system. 90.5% of participants reported that the proposed AFO classification system was clear, with 84% stating it was useful. The proposed classification system for bespoke thermoplastic AFOs, has an excellent inter- and intra-observer agreement. It will reduce the ambiguity of the description of the type of AFOs used in clinical practice and research. Furthermore, it makes reproducible comparisons between groups possible, which are essential for future evaluations of evidence-based orthotic care. • Standardised terminology for AFOs is critical, without these, there may be serious negative consequences. • No other classification system for bespoke thermoplastic AFOs currently exists.. • The proposed classification system based on AFO design and function has an excellent inter- and intra-observer agreement. • The classification system will allow comparisons between different bespoke thermoplastic AFOs and allow meta-analyses. • This classification is essential for evidence-based treatment of pathologies requiring bespoke thermoplastic AFO intervention. [ABSTRACT FROM AUTHOR]

Background Previous studies have demonstrated that stimulating the cutaneous plantar sensory receptors of the foot through textured insoles improves human balance and walking. This study investigated the effect of medial and lateral zoned textured insoles using tibialis anterior/peroneus longus surface electromyographic activity and Centre-of-Pressure as indicators of postural stability while walking. Methods 15 asymptomatic subjects were tested using a within-subject randomised repeated measures design. The effect of lateral and medial zoned insoles of varying heights (control, 2, 4 and 6 mm) on stability while walking under normal and impaired visual conditions was assessed. Results Impaired vision resulted in an increase in foot CoP variability while walking ( p < 0.05). The laterally zoned insole was associated with a significant (repeated measures ANOVA p < 0.05) increase in the rate of medial–lateral CoP change. Conclusion These findings suggest that the site of stimulation of the plantar foot cutaneous receptors may increase postural instability during walking. This should be considered in the design of insoles that aim to improve balance and reduce falls risk. The importance of vision in balance control has been highlighted and using impaired vision may serve as a way of trialling clinical products in the healthy population. [ABSTRACT FROM AUTHOR]

Abstract: Background: Previous research has found that ankle joint equinus can lead to foot pathologies. Calf stretching exercises are a common treatment prescription; however, no dynamic quantitative data on its effectiveness is available. Objective: To investigate the effect of calf muscle stretching on ankle joint dorsiflexion and subsequent changes within dynamic forefoot peak plantar pressures (PPP), force and temporal parameters. Method: Thirteen runners with ankle joint equinus were required to perform calf muscle stretching twice a day (morning and evening) on a Flexeramp. Measurements were collected on day 1, week 4 and week 8. A repeated measures ANOVA with Bonferroni-adjusted post hoc comparisons was used to assess differences across the three data collection sessions. Results: Findings indicated that the calf stretching program increased ankle joint dorsiflexion significantly (from 5° to 16°, p ≤0.05). The adaptive kinetics brought about by the increased ankle joint range of motion included significantly increased forefoot PPP and maximum force during stance phase but decreased time between heel contact and heel lift and total stance phase time. Conclusion: The calf stretching programme used in this study was found to increase ankle joint dorsiflexion and hence can be used for first line conservative management of ankle equinus. [Copyright &y& Elsevier]

Background Radiographic angles are commonly used in patients with hallux valgus deformity to assess the severity, plan surgery, assess outcome and compare results. Many different manual methods have been used, but are prone to error. More recently computer-assisted methods using software have become available. Objective To review the different methods that have been used to measure radiographic angles in hallux valgus. Method A general literature search using relevant key words was undertaken using databases such as Medline, Embase, Cinahl and Cochrane Library. Review findings and discussion The manual methods used are prone to errors. The reliability can be improved by using standardised radiographic technique and measurement technique using specific reference points. Computer-assisted methods using software, might improve reliability of measurements. Further studies are needed to assess if these methods are easy to use, and to compare different software's that are available. Specifically designed software for the foot might further improve the reliability of radiographic measurements in hallux valgus. [ABSTRACT FROM AUTHOR]

Background Appropriate conservative treatment is considered essential to address symptoms associated with tibialis posterior tendon dysfunction (TPTD) and prevent its potential long-term disabling consequences. The main aim of this review, undertaken in 2007, was to evaluate the evidence from studies for the effects of conservative treatment modalities in the management of TPTD. This evidence could then be used as a basis for the development of a clinical guideline for the management of the condition. Methodology Studies were selected according to specific criteria and evaluated for methodological quality. As preliminary literature searches had identified no randomised controlled trials at the time of the review, studies of lower hierarchy were included. Results Five uncontrolled observational studies evaluating the outcomes of various orthotic treatments alone or in combination with other therapies were included in the review. Different study designs, methodological quality, population characteristics, interventions and outcome measures were found. Discussion Limited and poor quality evidence was found in this review regarding the conservative treatment of TPTD. Thus a cause-effect relationship between intervention and outcome could not be established nor an optimal conservative treatment regime for the condition. Further better quality research is warranted in this area to inform practice, particularly as there is no consensus in the literature regarding treatment of this condition. [ABSTRACT FROM AUTHOR]

Background This investigation was aimed at examining whether subjects who wear a combination of functional foot orthoses and dental appliances have less postural sway and furthermore to study if these changes are direction dependent. Methods Centre of pressure (CoP) displacement in seven subjects, mean age 49 range (39-58) who met the inclusion criteria were evaluated using a pressure platform. Total displacement of the centre of pressure, the reduction in the displacement about the origin, area of the ellipse, total displacement along the x- and y-axes and frequency of sway along the anterior-posterior and mediolateral axes were estimated under four conditions, namely wearing orthoses and appliances, wearing only orthoses, only appliances and finally wearing neither orthoses nor appliances. Results In the six patients who had class II malocclusion there was no significant difference between the displacement (z = 0.314 and p = 0.753) and the frequency (z = 0.680 and p = 0.496) of sway along the medio-lateral or anterior-posterior axes. Under control conditions the mean path length was 780 (SD 415) mm, the mean deviation from origin was 4.76 (SD 5.8) mm and the mean area was 0.83 (SD 1.87) mm2/cm2. The mean deviation from origin was seen to reduce under all experimental conditions. Wearing the dental appliance alone was seen to be the most effective although the difference was not statistically significant. The sway area was also seen to reduce under all experimental conditions. The sway was most reduced when participants were wearing orthoses (i.e. conditions 1 and 3) with the reduction being the greatest when the orthoses was worn on its own (i.e. condition 3). Conclusion While, foot orthoses have been used for the relief of symptoms either within or extrinsic to the foot, they could have a much wider role in the management of patients with stability problems. Results from this study highlight the need for further research in this exciting and as yet unexplored area. [ABSTRACT FROM AUTHOR]

• Terms that describe different types of AFOs has not been standardised and defined. • Lack of standardisation affects research and clinical practice. • It is time to expand on the current ISO definitions for orthotic practice. The term Ankle Foot Orthosis (AFO) has been standardised and defined by the International Organization for Standardisation which offers general terms for external orthoses, describing terms relating to external orthoses including the abbreviation AFO. These standards relate to functional deficiencies including a description of the person to be treated with an orthosis, clinical objectives of treatment, and functional requirements of the orthosis and offers categorisation and description of external orthoses and orthotic components using the aforementioned standards. However, it is important to point out that these definitions and standardisations only apply to the term "AFO". Yet the terms used to describe the different types of AFOs have not been standardised and defined. [ABSTRACT FROM AUTHOR]

• Understanding the effects of biomechanically optimised AFO-FC is vital for clinical management. • Tuning AFO-FCs can potentially improve hip and pelvic movement in children with CP. • Knee extension during stance and knee flexion in swing phase is also improved with tuned AFO-FCs. • This novel, structured case series analysis shows the effect of AFO-FC tuning on gait kinematics. Case series. AFOs are a commonly prescribed medical device given to children with cerebral palsy (CP) in an attempt to improve their gait. The current literature is equivocal on the effects AFOs have on the gait of children with CP. The vast majority of AFOs issued are not subject to AFO-FC tuning. There are emerging studies investigating the effects tuning AFO-FCs has on the gait of children with CP. However, the research is limited, and there is a lack of quantitative data. To compare the kinematics of tuned versus non-tuned gait in children with CP. Gait analysis assessment of five children aged between 7–11 years with a diagnosis of CP (one hemiplegic and four diplegic participants, two female, three male, with a Gross Motor Functional Classification System (GMFCS) of 2) at a Gait Analysis Laboratory. In comparison to barefoot and non-tuned gait, walking with a tuned AFO-FC produced improvements in several key gait parameters. Including hip flexion and extension, posterior pelvic tilt and knee extension. Results also indicated that the type of gait pattern demonstrated by the participant affected the outcomes of tuning. Tuning the AFO-FC of children with CP has the potential to improve hip function, pelvic function, knee extension in stance phase and knee flexion during swing phase and that a non-tuned AFO-FC can potentially decrease hip function, posterior pelvic tilt and increase knee extension. Whilst AFO-FC tuning has been recommended for routine clinical practice, there still remains a paucity of research on the kinematic effects of using a tuned AFO-FC compared to a non-tuned. This paper provides a comparison of kinematics on children with CP, during barefoot, non-tuned and tuned AFO-FC walking with a view to inform clinical practice. [ABSTRACT FROM AUTHOR]

• Understanding patient adherence is crucial to effective treatment interventions. • The importance of function outweighs the cosmetic element of orthotic treatment. • Results indicate that a holistic approach to orthotic treatment is warranted. Pilot study. Ankle foot orthoses (AFOs) and footwear combination (FC) is a commonly prescribed medical device given to children with cerebral palsy (CP) in an attempt to improve their gait. Biomechanically optimising the AFO-FC often requires large adaptations to the sole of the user's footwear. There is currently a dearth of literature regarding the user's perception of wearing biomechanically optimised AFOs and adapted footwear and whether their perception affects their adherence to orthotic treatment. This study aimed to investigate perception and adherence to wearing an AFO and FC the participants were asked to wear as part of their orthotic prescription. In particular, whether the visibly modified footwear affected the user's adherence to the orthotic treatment. Questionnaire devised for the purpose of this study. All five participants responded to the questionnaire; reporting a high number of positive responses in relation to function, including; an improvement in the way they walked, improved balance and fewer falls. Conversely, there was a high level of negative responses regarding aesthetics, with all participants reporting they did not like the cosmesis of their AFO-FCs. They were conscious that the modification to their footwear was noticeable and therefore different from their peers, yet they adhered to the treatment and in some cases increased the wearing time. This pilot set of questions indicated that cosmesis is an important factor for children who wear AFOs and adapted footwear. It can be concluded that the impact of the adapted AFO-FC on the participants' function outweighed their opinion on the cosmesis of the device. It is vital to understand how orthotic prescriptions affect user adherence. Orthotic prescriptions which are not utilised by the user result in a failed treatment intervention, regardless of the scientific application underpinning them. [ABSTRACT FROM AUTHOR]

Aim: To investigate if the assessment of the mechanical properties of plantar soft tissue can increase the accuracy of predicting Diabetic Foot Ulceration (DFU).Methods: 40 patients with diabetic neuropathy and no DFU were recruited. Commonly assessed clinical parameters along with plantar soft tissue stiffness and thickness were measured at baseline using ultrasound elastography technique. 7 patients developed foot ulceration during a 12months follow-up. Logistic regression was used to identify parameters that contribute to predicting the DFU incidence. The effect of using parameters related to the mechanical behaviour of plantar soft tissue on the specificity, sensitivity, prediction strength and accuracy of the predicting models for DFU was assessed.Results: Patients with higher plantar soft tissue thickness and lower stiffness at the 1st Metatarsal head area showed an increased risk of DFU. Adding plantar soft tissue stiffness and thickness to the model improved its specificity (by 3%), sensitivity (by 14%), prediction accuracy (by 5%) and prognosis strength (by 1%). The model containing all predictors was able to effectively (χ2 (8, N=40)=17.55, P<0.05) distinguish between the patients with and without DFU incidence.Conclusion: The mechanical properties of plantar soft tissue can be used to improve the predictability of DFU in moderate/high risk patients. [ABSTRACT FROM AUTHOR]